Trauma of the optic nerve: A diagnostic and therapeutic disaster

In the course of 2 1/2 years the authors saw five patients with blindness of one or both eyes. All patients were admitted to their clinic after accidents and trauma in an unconscious state. All five patients had a midfacal fracture. In two instances where X-ray photography indicated a clearcut mechanical compression they performed a decompression of the canal. However, the effect was negligible. The disappointing experience was compared with the literature.In particular, in case of unconsciousness of the patients the problem of the exact diagnosis is very difficult. The experiences with visual evoked potentials are not very reliable. It is still very difficult to arrive at a proper diagnosis without the patient's collaboration. Consequently, up to now it is very difficult to lay down definite rules for the therapy. It is equally impossible to give a proper prognosis in all those cases that are suspected of a lesion of the optic nerve.

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